Teens' Eating Disorders Signal Other Psych Problems

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According to this study, adolescents have eating disorders at rates only slightly lower than adults -- and most teens with the problem have at least one other psychiatric comorbidity, including suicidal thoughts.

Note that girls were more likely to report bulimia, binge eating, and sub-threshold anorexia, but there were no sex differences in anorexia or in sub-threshold binge eating.

Adolescents have eating disorders at rates only slightly lower than adults -- and most teens with the problem have at least one other psychiatric comorbidity, including suicidal thoughts, researchers reported.

But while a majority of teens do appear to be willing to seek help for psychological comorbidities, they do not appear to be receiving treatment specifically for the eating disorder, according to Kathleen Merikangas, PhD, of the National Institute of Mental Health in Bethesda, Md.

Merikangas and colleagues reported the findings online in Archives of General Psychiatry.

Studies of adults suggest that the rates of anorexia nervosa and bulimia nervosa range from 0.5% to 1.0% and from 0.5% to 3.0%, respectively, the researchers noted.

So-called "eating disorder not otherwise specified" -- which includes binge eating -- tends to be more frequently diagnosed in clinical settings among adults, Merikangas and colleagues noted.

On the other hand, they added, little is known about the prevalence or correlates of these disorders among adolescents.

So the research team turned to the National Comorbidity Survey Replication Adolescent Supplement, which involved face-to-face interviews with a nationally-representative sample of 10,123 adolescents, ages 13 through 18.

The investigators examined the prevalence of anorexia nervosa, bulimia nervosa, and binge-eating disorder, defined according to diagnostic criteria found in the DSM-IV, as well as broader "sub-threshold" anorexia and binge eating categories.

They found that:

The lifetime and 12-month prevalences of anorexia nervosa were 0.3% and 0.2%, respectively.

The corresponding rates for bulimia were 0.9% and 1.1%, respectively.

The rates for binge-eating disorder were 0.8% and 0.9%, respectively, while the rates for sub-threshold binge eating were 2.5% and 1.1%, respectively.

The lifetime prevalence of sub-threshold anorexia was 0.8% but the 12-month prevalence wasn't calculated.

There was not enough information to calculate prevalences for sub-threshold bulimia nervosa.

Interestingly, there were no sex differences in anorexia or in sub-threshold binge eating, while girls were more likely to report bulimia, binge eating, and sub-threshold anorexia, the researchers reported.

Most survey participants who reported an eating problem also reported at least one other psychiatric disorder classified in the DSM-IV, Merikangas and colleagues found.

Specifically, the rates of teens reporting a comorbidity were 55.2% for anorexia, 88% for bulimia, 83.5% for those with binge eating, 79.8% for those sub-threshold anorexia, and 70.1% for those with sub-threshold binge eating.

Merikangas and colleagues cautioned that the cross-section design of the study means that it is not possible to make conclusions about the temporal relationships of eating disorders and comorbid conditions.

Suicidal thoughts, planning, and attempts were also commonly reported, from a low of 2.3% of teens with anorexia reporting planning suicide to a high of 53% of those with bulimia reporting suicidal ideation, the researchers found.

Most participants with an eating disorder had sought care at some point, with rates ranging from 64.2% for those with sub-threshold binge eating to 88.2% for those reporting bulimia, the investigators reported.

But the investigators found that only a minority of the teens had specifically sought treatment for their eating disorder, with rates ranging from 3.4% among those with sub-threshold binge eating to 27.5% for those with anorexia.

The researchers cautioned that, among other limitations, the small numbers of teens with an eating disorder found in this survey means that analyses of possible associations may have been under-powered.

Nonetheless, they concluded that the study "provides key information concerning the epidemiology of eating disorders" among U.S. teens and shows that they "represent a major public health concern."

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